The increase will average 19% and will take effect Oct. 1 along with double-digit hikes by Anthem Blue Cross, Blue Shield of California and Health Net that also had been reviewed by the Department of Insurance.

More than 1 million Californians will see their health insurance premiums rise Oct. 1 now that regulators have wrapped up their review of a plan by Aetna Inc. to raise rates an average of 19% for 65,000 individual policyholders.

Aetna was cleared Friday by the state Department of Insurance to proceed with its new plan. It was the last of four major insurers to be reviewed by the department, which has OKd double-digit rate increases by Anthem Blue Cross, Blue Shield of California and Health Net Inc. in the last month.

Regulators stepped up their scrutiny of the insurers after Anthem announced plans earlier this year to raise premiums by as much as 39%, triggering a backlash among policyholders, lawmakers and the White House. The insurer canceled the hikes and sought smaller increases that were allowed.

The insurance department has no authority to block rate hikes as long as they comply with California law, which requires insurers to devote at least 70 cents of every premium dollar to medical claims.

Aetna's plan met that threshold, the state concluded Friday. All of the hikes reviewed by the state take effect Oct. 1.

"The Department of Insurance in no way condones or supports these insurance rate increases on California policyholders, but the unfortunate reality is that legally insurers are entitled if their rate filings are found to be in line with state law," spokesman Ioannis Kazanis said.

Aetna welcomed the insurance department's decision and defended its rate increase as a necessary move to keep up with rising healthcare costs. The company said its maximum increase for a fraction of its members would be 30%.

"We are pleased that, after extensive and thorough review, the [department] has accepted the rates for Aetna's individual products in California," said Beth Anderson, president of Aetna's west region.

"Rate increases are never easy, but the growing market trends we are seeing in California — such as the increasing prices for hospital care, prescription drugs, doctor's visits and other healthcare services — directly impacts what our members pay."

Some Aetna policyholders voiced alarm at the coming increase, saying double-digit hikes each year could soon put insurance beyond their reach. Dave and Jo Nixon, for example, will see their annual cost rise 23%, to $17,676 from $14,340. The San Jose couple also have a $3,000 deductible.

"The trend is just crazy," said Dave Nixon, 56. "In two or three years, I'll be paying more for my health insurance than my rent."

Aetna and the other insurers had put their rate increases on hold since July while an outside consultant to the insurance department reviewed their paperwork.

Aetna announced last month that it was going forward with its Oct. 1 increases before the consultant had finished his review. The state would not give its consent until that work was finished.

The analysis of Aetna took longer than the others as the consultant, the insurance department and the insurer negotiated how the company would establish a reserve fund to hold down future rate increases.

The insurers lost tens of millions of dollars during the delay. They said they were looking forward to moving ahead Oct. 1.

Blue Shield premiums will increase an average of 19%, and as much as 29%, for 250,000 customers.

Health Net rates will go up an average of 16%, and as high as 25%, for 38,000 customers.

Anthem rates will rise an average of 14%, and as much as 20%, for about 800,000 individual policyholders — down from an average of 25% and a cap of 39%.

"We understand Californians need healthcare they can afford and Anthem Blue Cross is committed to working toward solutions that bring costs down and improve health," spokeswoman Kristin Binns said. "We look forward to continuing to serve our members across the state."